A large increase in Hepatitis A cases in Ohio has state health officials concerned.

There have been 47 cases of the highly contagious liver infection confirmed this year compared to just five cases at this same time last year, according to the Ohio Department of Health.

Ohio epidemiologist Sietske De-Sijter says there is no one reason for the jump, but severe outbreaks in Kentucky, Michigan, and West Virginia are linked to the increase in Ohio. Michigan Health officials report 800 cases, and Kentucky public health officials have identified 311 confirmed cases Since Jan. 1, 2017.

“It’s usually spread when a person ingests fecal matter and it’s very small amounts from contacts with objects, fruits, or drinks, contaminated with the stool of an infected person,” said De-Sijter. It is not spread through casual contact, she said.

Among those at greatest risk are people in direct contact with someone who already has Hepatitis A, those who use street drugs and men who have sex with men, she said.

The Ohio Department of Health recommends people in the high-risk groups, including those who have traveled to places where the virus is prevalent, be vaccinated.

The symptoms include:

Fatigue

Nausea

Stomach pain

Loss of appetite

Vomiting

Grey-colored stools

Joint pain

Dark urine

Jaundice

According to the Centers for Disease Control, most people who get Hepatitis A feel sick for several months, but they usually recover without lasting liver damage. In rare cases, it can be deadly.